Seizures in meningioma.

Area of Science:

• Neurosurgery
• Neurology
• Oncology

Background:

• Meningiomas are common primary brain tumors, with over one-third of patients experiencing seizures.
• Meningioma-associated epilepsy is understudied, with research often prioritizing tumor progression and survival.
• Epilepsy significantly affects patient quality of life, necessitating research into seizure prediction and management.

Purpose of the Study:

• To review seizure rates and predictors in meningioma patients.
• To discuss surgical and medical treatment options for meningioma-related epilepsy.
• To identify factors influencing preoperative seizures and postoperative seizure freedom.

Main Methods:

• Review of previously reported rates and predictors of seizures in meningioma.
• Analysis of factors associated with preoperative epilepsy.
• Evaluation of outcomes following tumor resection and associated predictors of persistent or new-onset seizures.
• Discussion of antiepileptic drug (AED) selection and prophylaxis.

Main Results:

• Preoperative epilepsy affects approximately 30% of meningioma patients; peritumoral edema is a key predictor.
• Factors predicting preoperative seizures include young age, male gender, absence of headache, and non-skull base location.
• Around 70% of patients with preoperative epilepsy achieve seizure freedom post-surgery.
• Persistent seizures are linked to prior epilepsy, edema, skull base location, tumor progression, and epileptiform discharges.
• About 10% of patients without preoperative epilepsy develop new seizures post-surgery, associated with tumor progression, radiation, and gross total resection.
• Antiepileptic drugs are effective for both pre- and postoperative seizures, but prophylaxis is not recommended.

Conclusions:

• Peritumoral edema and tumor characteristics are significant predictors of seizures in meningioma patients.
• Surgical resection can lead to seizure freedom in a majority of patients with preoperative epilepsy.
• Further research into medical and surgical strategies is essential for managing meningioma-related epilepsy.